WASHINGTON, D.C. (WVVA) – U.S. Senators Tim Kaine (D-VA) and Michael Bennet (D-CO) reintroduced the Medicare-X Choice Act on December 5th, 2025, proposing a public health insurance option that would operate within the frameworks of the Affordable Care Act and Medicare. The bill would create a Medicare Exchange, known as Medicare-X, intended to give individuals, families and small businesses an additional affordable coverage choice in every county across the country.
The sponsors say Medicare-X would lower the uninsured rate, reduce household health spending and increase competition in the insurance market. The reintroduction comes as lawmakers debate extensions of premium tax credits and as, the release states, more than 14 million Americans face coverage losses tied to federal Medicaid cuts and the expiration of enhanced premium tax credits.
What Medicare-X would do:
- Establish a public option plan that is available countywide, building on Medicare and ACA rules
- Permanently extend enhanced premium tax credits to make exchange coverage more affordable
- Require Medicare-X plans to cover essential health benefits, including maternity and newborn care, pediatric services and mental and behavioral health care
- Cover primary care services with no cost-sharing for plan holders under Medicare-X, according to the sponsors
Supporters point to projected savings and coverage gains. The Urban Institute’s 2022 analysis cited in the release estimated Medicare-X could reduce the number of uninsured by about 1.1 million, save households $10.9 billion, and cut national health spending by $456 billion over ten years.
Kaine urged Republican colleagues to extend enhanced premium tax credits while lawmakers work on longer-term solutions like Medicare-X
Bennet said the nation faces a looming health care crisis because of Medicaid reductions and expiring credits.
Cosponsors and background The bill is cosponsored by U.S. Senators Cory Booker (D-NJ), Tammy Duckworth (D-IL), Tina Smith (D-MN), Rev. Raphael Warnock (D-GA), John Hickenlooper (D-CO) and Amy Klobuchar (D-MN). Kaine and Bennet first introduced Medicare-X in 2017.
Advocates and analysts say a public option could increase competition in local insurance markets where a small number of private insurers dominate. Supporters also argue that offering primary care with no cost-sharing could reduce avoidable hospitalizations and improve preventive care access.
Opponents typically raise concerns about government competition with private insurers, fiscal impacts, and the pace of transition. The reintroduced bill aims to address affordability and coverage gaps while maintaining ACA protections for people with pre-existing conditions.
Next steps
Legislative consideration will depend on committee referrals, hearings and floor action. The bill text and a summary are available from Senator Kaine’s office:
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